Facts on prostate cancer

It's been aptly said if you're not confused about prostate cancer, you don't know what's going on.

Every year I receive letters from men who have been diagnosed with this malignancy. They all ask, "what is the best treatment?"

Here are facts to consider before making a decision.

AGE IS VITAL: If you're 70, you have a greater chance of dying from other diseases before prostate cancer kills you. Or as one prominent urologist remarked, "Getting older is invariably fatal, prostate cancer only sometimes."

Prostate cancer is a little like getting grey hair. By age 70, autopsies show that 45% of prostate glands contain cancer cells.

QUALITY OF LIFE AFTER TREATMENT: A report from the University of Toronto states 60% of men aged 39 to 79 years of age were impotent following radical surgery. Eight percent suffered from urinary incontinence.

The patient who wets his pants after radical prostatectomy is much more aware of this problem than the surgeon who performs the operation.

Most letters I receive from patients left with post-surgical incontinence tell a sad tale. The writers would not have agreed to surgery if they had known how difficult it was to live with urinary incontinence. No one wants to end their life in diapers.

There are several treatments available.

WATCHFUL WAITING: This is often the most prudent strategy for elderlya men with slow-growing malignancies.

Urologists can monitor the tumour by rectal examination and PSA tests. If significant changes appear in either the prostate gland or PSA, treatment can be started.

RADIATION THERAPY: This can be administered in two ways.

The most common approach is external radiation. This involves short, powerful bursts of radiation over a six-week period. It's a good alternative for elderly males with medical problems which make them poor surgical risks. Or if there's doubt the cancer can be completely removed.

BRACHYTHERAPY: This involves the implanting of dozens of radioactive seeds in the prostate gland.

Since radiation is confined to the gland, it is less likely to affect surrounding tissues. But it can still cause erectile dysfunction, incontinence and diarrhea.

It's popular with patients because it's a short procedure and patients can usually return to work in a few days.

The big question is whether this method destroys all cancer tissue or leaves "cold spots" where cancer cells survive and can become life-threatening.

Seed therapy works best for those with small tumours and low levels of PSA. But when tumours were more advanced, the five-year survival rate was lower.

HORMONE THERAPY: This attacks cancer cells in a different way. It slams the door on the male hormone testosterone, that fuels the growth of malignant cells. This approach kills cancer cells in the prostate gland and elsewhere in the body.

Testosterone is decreased by either removing the testicles or by drugs which prevent the production of testosterone. Side-effects include loss of sexual desire, impotence and hot flushes. Some patients also complain of breast swelling, nausea and vomiting.

CHEMOTHERAPY: This is used when cancer has not been controlled by other treatment. It can at times help to decrease symptoms and improve the quality of life.

PAIN CONTROL: It's vital when all other treatments fail. In this case, make sure you communicate to the doctor that adequate medication should be prescribed and not to worry about addiction.

Patients who need narcotics for pain do not become addicted since pain consumes the addictive qualities of morphine.